Ozempic and GLP-1 lawsuit MDL 3094: where the gastroparesis and NAION litigation actually stands

The GLP-1 receptor agonist litigation is among the fastest-growing pharmaceutical mass torts in active development. MDL 3094 (In re: Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) Products Liability Litigation), centralized in the U.S. District Court for the Eastern District of Pennsylvania before Judge Karen Spencer Marston, consolidates approximately 3,636 federal cases as of May 2026 alleging that GLP-1 medications cause severe gastrointestinal injuries including gastroparesis (stomach paralysis), ileus, intestinal obstruction, and gallbladder disease. A separate MDL 3163 in the same district before the same judge covers non-arteritic anterior ischemic optic neuropathy (NAION) vision loss cases, with 86 cases pending as of May 2026 and a Science Day scheduled for June 2, 2026. The defendants are Novo Nordisk (manufacturer of Ozempic, Wegovy, and Rybelsus, all containing semaglutide) and Eli Lilly (manufacturer of Mounjaro and Zepbound, containing tirzepatide).

The procedural posture in mid-2026 reflects active discovery without bellwether trial selection completed. Judge Marston assumed oversight of MDL 3094 after Judge Pratter's unexpected passing in May 2024. Judge Marston's August 15, 2025 evidentiary ruling established that gastroparesis claims require objective diagnostic evidence, specifically, gastric emptying studies confirming abnormal retention times. The ruling excluded alternative evidence (CT scans, MRIs, endoscopy, ultrasound findings, barium studies, or temporal symptom correlation) as insufficient for causation purposes. The ruling has affected case qualification, plaintiffs without gastric emptying study results face material weakness in their cases.

The litigation's theory focuses on adequate warning. GLP-1 medications were initially approved for diabetes treatment but became wildly popular for off-label weight loss use, eventually leading to FDA-approved weight loss indications (Wegovy in 2021; Zepbound in 2023). The medications work by slowing gastric emptying, the same mechanism that produces weight loss can produce severe gastroparesis in some patients. The plaintiffs allege that Novo Nordisk and Eli Lilly knew or should have known about the increased gastroparesis risk and failed to adequately warn patients and prescribers. A 2023 JAMA Internal Medicine study linked GLP-1 medications to substantially increased risk of gastroparesis. A 2024 VA study supports the NAION risk connection.

Total liability across the litigation could exceed $2 billion. With cases continuing to grow (more than 100 new GLP-1 lawsuits filed in early May 2026 alone), the litigation is positioned to become one of the largest active pharmaceutical mass torts. Bellwether trials are expected to begin in late 2026 or 2027.

This is the science behind the GLP-1 injury theories, the procedural history of MDLs 3094 and 3163, the eligibility framework including the gastric emptying study requirement, the strategic considerations for prospective plaintiffs, and how the litigation compares to other recent pharmaceutical mass torts.

What are GLP-1 receptor agonists?

GLP-1 receptor agonists are injectable or oral medications (including Ozempic, Wegovy, Mounjaro, and Zepbound) that mimic the natural hormone GLP-1 to regulate blood sugar and appetite. Originally developed for type 2 diabetes, they became widely used for weight loss. Their mechanism of slowing gastric emptying produces both the desired weight loss effect and the alleged injury risk of severe gastroparesis.

GLP-1 receptor agonists are a class of medications originally developed for type 2 diabetes treatment:

Mechanism of action. GLP-1 (glucagon-like peptide-1) is a naturally occurring hormone that regulates blood glucose and appetite. Synthetic GLP-1 receptor agonists activate the same receptors, producing several effects:

• Increased insulin secretion (improving diabetes control)
• Slowed gastric emptying (food remains in stomach longer)
• Increased satiety (feeling of fullness)

The slowed gastric emptying is central to the medications' weight loss effects, patients feel fuller longer and consume less food. But the same mechanism creates the alleged injury risk: in some patients, gastric emptying slows excessively, producing gastroparesis.

Novo Nordisk became Europe's largest company by market capitalization based largely on Ozempic and Wegovy sales. Eli Lilly's stock similarly benefited from Mounjaro and Zepbound success. The financial scale of the manufacturers means substantial resources available for both defense and potential settlement.

What injuries are alleged in the Ozempic and GLP-1 lawsuits?

The primary alleged injuries in MDL 3094 include gastroparesis (stomach paralysis), intestinal obstruction, gallbladder disease requiring surgical removal, pancreatitis, and cyclic vomiting syndrome. A separate MDL (3163) covers NAION, a condition causing sudden, often permanent vision loss.

The MDL 3094 cases involve various injury categories:

• Severe vomiting (sometimes requiring hospitalization)
• Malnutrition from inability to maintain adequate caloric intake
• Inability to digest solid foods
• Need for special diets or feeding modifications
• In some cases, gastric pacemaker implantation or surgical intervention

Intestinal obstruction (ileus). Reduced gastrointestinal motility can produce intestinal blockage, requiring:

Gallbladder disease. Some plaintiffs developed gallbladder problems requiring:

Pancreatitis. Inflammation of the pancreas requiring medical intervention.

Cyclic vomiting syndrome. Recurrent episodes of severe vomiting.

Other gastrointestinal complications. Severe nausea, vomiting, and dehydration requiring hospitalization.

The MDL 3163 cases involve a specific eye injury:

Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION). A condition causing sudden, often permanent vision loss in one or both eyes.

• Reduced blood flow to the optic nerve
• Ischemic damage to optic nerve fibers
• Permanent vision impairment in the affected eye(s)

NAION typically affects 1 in 10,000 users by some estimates, but the severity of injury (often permanent blindness in the affected eye) produces substantial damages.

What is the procedural history of MDL 3094?

MDL 3094 was consolidated in the Eastern District of Pennsylvania in September 2024 and has grown to approximately 3,636 cases as of May 2026. Judge Marston's August 2025 ruling requiring gastric emptying study evidence for gastroparesis claims was a pivotal moment. Bellwether case selection is underway in 2026, with trials expected in late 2026 or 2027. A separate NAION Science Day is set for June 2, 2026.

2023. First Ozempic gastroparesis lawsuits filed in various jurisdictions. JAMA Internal Medicine study published linking GLP-1 medications to gastroparesis risk.

September 2024. Judicial Panel on Multidistrict Litigation consolidated federal Ozempic and other GLP-1 cases into MDL 3094 in the Eastern District of Pennsylvania.

Judge Karen Spencer Marston assumed oversight of the MDL.

Throughout 2024-2025. Active discovery including document production from Novo Nordisk and Eli Lilly, expert reports, and case management orders.

August 15, 2025. Judge Marston's landmark evidentiary ruling.

• Gastroparesis claims require objective diagnostic evidence
• Specifically, gastric emptying studies showing abnormal retention times
• Alternative evidence (CT scans, MRIs, endoscopy, etc.) insufficient
• Plaintiffs without GES evidence face material case weakness

Many existing plaintiffs and counsel scrambled to obtain proper diagnostic testing.

October-December 2025. Fact discovery closure (October 2025) and expert report deadlines (December 2025) per case management orders.

Throughout 2025. Case count grew from approximately 1,800 (mid-2025) to approximately 3,546 (April 2026).

Judge Marston emphasized maintaining litigation momentum while ensuring thorough discovery processes.

June 2, 2026. Science Day scheduled for NAION cases, comprehensive scientific evidence presentation about the connection between GLP-1 medications and NAION.

Mid-2026. Bellwether selection expected to be finalized. First bellwether trials anticipated late 2026 or 2027.

Parallel state court litigation. New Jersey established a multicounty litigation (MCL) for NAION cases.

• Establishing general causation evidence (whether GLP-1 medications can cause the alleged injuries)
• Resolving scientific disputes about long-term gastrointestinal damage
• Preparing bellwether cases for trial
• Coordinated discovery across federal and state proceedings

Who is eligible to file an Ozempic or GLP-1 lawsuit?

To qualify for a GLP-1 lawsuit, a plaintiff generally needs documented use of a GLP-1 medication (such as Ozempic, Wegovy, or Mounjaro), a qualifying injury that developed during or shortly after use, and no dominant alternative cause. For gastroparesis claims specifically, Judge Marston's August 2025 ruling requires a gastric emptying study showing abnormal retention times as objective diagnostic proof.

Documented GLP-1 medication use. Records showing the claimant used Ozempic, Wegovy, Rybelsus, Mounjaro, or Zepbound (or similar GLP-1 medications).

Duration considerations. Generally requires substantial use period (months to years) to establish causation. Very brief use is less likely to produce the cumulative injury patterns supporting case theories.

For gastroparesis claims under post-August 2025 ruling:

• Gastric Emptying Study (GES) showing abnormal retention times, THIS IS NOW REQUIRED

• Wireless motility capsule study (alternative GES method)

• Other objective testing methods specifically authorized by the court

• NOT sufficient under current ruling: CT scans, MRIs, endoscopy, ultrasound, barium studies, or temporal symptom correlation alone

• Medical records documenting ileus, intestinal obstruction, gallbladder disease, pancreatitis, or other qualifying conditions

• Treatment records including any surgical interventions

• Hospital admission records for severe presentations

• Ophthalmology records documenting NAION diagnosis

• Optical coherence tomography (OCT) imaging

• Documentation of sudden vision loss onset

Temporal connection. The injury developed during or shortly after GLP-1 medication use. Pre-existing conditions of the same type weaken the case substantially.

No significant alternative causation. Cases with strong alternative explanations (pre-existing diabetic gastroparesis, prior NAION events from other causes, etc.) face more difficult causation analysis. The plaintiff doesn't need to show GLP-1 was the sole cause, but the case is stronger when alternative causes are less prominent.

Statute of limitations compliance. State-specific limitations periods apply. Many states have 2-3 year limitation periods. The discovery rule may provide some flexibility but has limits.

Age limitation. Most firms require plaintiffs under 75 due to causation complexity for elderly plaintiffs with multiple potential alternative causes.

A patient who used Ozempic, Wegovy, or another GLP-1 medication for at least 6 months, was diagnosed with severe gastroparesis through a gastric emptying study, required medical intervention beyond outpatient management (hospitalization, surgical procedures, gastric pacemaker, ongoing specialized treatment), has comprehensive medical records establishing the timeline, and has no significant alternative causation factors.

How does the gastric emptying study requirement change the Ozempic lawsuit?

Judge Marston's August 2025 ruling now requires plaintiffs alleging gastroparesis to present gastric emptying study (GES) results showing abnormal retention times as objective proof. Alternative imaging (CT scans, MRIs, endoscopy, barium studies) is no longer sufficient. This narrows the pool of qualifying cases but strengthens the remaining claims, focusing the MDL on cases with the most robust scientific evidence.

The August 2025 ruling requiring gastric emptying study evidence affects the litigation:

Pre-ruling case qualification. Many existing plaintiffs had been qualified based on symptoms, clinical diagnosis, and imaging short of formal GES testing. The pre-ruling qualification standards were more permissive.

Post-ruling case qualification. Plaintiffs without GES evidence may need to:

• Obtain GES testing now (years after injury onset, which can complicate the evidence)
• Have their cases re-evaluated for continued viability
• Potentially face case dismissal if GES results don't confirm gastroparesis
• Consider alternative injury claims (gallbladder, NAION, etc.) if GES doesn't support gastroparesis

Strategic implications. Counsel pursuing GLP-1 cases must now:

• Verify GES evidence before case acceptance
• Coordinate with treating physicians to obtain proper testing
• Document the timeline of testing relative to medication use
• Address GES result interpretation in case strategy

The ruling represents Judge Marston's effort to ensure that the MDL focuses on cases with objective scientific support. The framework has both benefits (focuses litigation on strongest cases) and costs (excludes cases that may have legitimate injuries without proper diagnostic testing).

What are the projected settlement amounts in the Ozempic lawsuit?

Early projections estimate $400,000 to $700,000 per severe gastroparesis case involving gallbladder removal or similar complications, $250,000 to $500,000 for gastroparesis with ongoing treatment, and potentially over $1 million for NAION cases involving permanent vision loss. Total litigation exposure across all claims may exceed $2 billion, though final values depend on bellwether trial outcomes expected in late 2026 or 2027.

Total litigation exposure: Estimated $2+ billion across the litigation. Novo Nordisk and Eli Lilly both have substantial financial capacity for resolution.

Patient navigation of the extended timeline is required.

How does GLP-1 litigation compare to other mass torts?

GLP-1 litigation is one of the fastest-growing pharmaceutical mass torts, with roughly 3,636 cases and climbing.

The broader procedural framework for mass tort settlements is detailed in our overview of how mass tort litigation works. GLP-1 represents one of the most rapidly growing mass torts with substantial total exposure but uncertain ultimate resolution timeline.

What strategic considerations should GLP-1 plaintiffs keep in mind?

Prospective GLP-1 plaintiffs should prioritize obtaining a gastric emptying study (now required for gastroparesis claims), engage experienced GLP-1 litigation counsel, thoroughly document both medication use and injury timelines, and plan for an extended litigation process.

Obtain gastric emptying study immediately if not already done. The August 2025 ruling makes GES evidence essentially required for gastroparesis claims. Patients with gastroparesis symptoms but without GES testing should pursue testing through their treating gastroenterologists.

Engage experienced GLP-1 counsel. The MDL is procedurally specific with evolving evidentiary standards. Counsel with established GLP-1 case experience handles cases more effectively. Most plaintiffs' firms work on contingency basis (typically 30-40% of recovery).

• Pharmacy fill records showing duration of use

• Off-label use documentation (if applicable)

• Date of cessation (if discontinued)

• Symptom onset relative to medication use

• All diagnostic testing (GES is now essential for gastroparesis)

Consider multiple injury types. Some plaintiffs have multiple GLP-1 related injuries (gastroparesis + gallbladder + NAION).

Watch the June 2026 Science Day for NAION cases. The comprehensive scientific evidence presentation will substantially affect NAION case framework.

Don't accept inadequate settlements pre-bellwether. Some firms may offer early settlements before bellwether trials affect pricing. Have any settlement offer evaluated by experienced counsel.

Continuing medical treatment during the wait will be necessary for many plaintiffs.

Coordinate with treating physicians. Gastroenterologists, ophthalmologists, and other treating specialists are important witnesses. Their support for the case theory strengthens the case substantially.

Consider state court alternatives. State court filings may proceed faster than federal MDL in some jurisdictions.

Watch for additional defendants. Beyond Novo Nordisk and Eli Lilly, other GLP-1 manufacturers (or compounded GLP-1 products from compounding pharmacies) may face liability. Comprehensive case analysis identifies all potentially responsible parties.

The GLP-1 receptor agonist litigation represents accountability for one of the most commercially successful pharmaceutical categories in recent history. The medications produced enormous benefits for diabetes management and weight loss while allegedly causing serious gastrointestinal and ocular injuries in a meaningful subset of patients. The commercial success of the medications combined with the documented adverse effects creates the conditions for substantial mass tort litigation. The August 2025 evidentiary ruling has shaped case qualification by requiring objective diagnostic evidence. For potential plaintiffs whose serious injuries developed during or shortly after GLP-1 medication use, the framework provides paths to compensation that require proper documentation, experienced counsel, and patience with the extended timeline. The work for plaintiffs is engagement with qualified counsel familiar with the post-August 2025 evidentiary framework, comprehensive medical documentation including gastric emptying study evidence for gastroparesis claims, careful coordination with treating physicians, and informed decision-making throughout the extended litigation timeline.

This post is informational and does not constitute legal advice. If you believe you have a GLP-1 related injury, consult a qualified attorney to evaluate your specific circumstances.